TWilliam2019
Guru
Operations:
#1. Left carotid artery endarterectomy with Hemashield patch closure 35301 LT
#2. Post endarterectomy duplex analysis with interpretation 93882 26
#3. Excision of left internal jugular lymph node at the C sent to pathology for permanent evaluation) ?
*
Preoperative note: Patient is 63 y.o.-old female with severe left carotid artery disease now being taken to the operative for operative therapy.
*
Operative findings:
#1. Duplex findings: Following the endarterectomy the carotid artery was scanned in longitudinal and transverse planes including the common, bifurcation, internal, and external vessels. There were no filling defects or obstructive findings involving any of the vessels on on this imaging. Doppler analysis was carried out and the velocities in the meters per second are as follows: Common 47/11, bifurcation 38/0, external 41/0, internal 102/9.
#2. Operative findings: There was a significantly enlarged left internal jugular lymph node at the level of the carotid bifurcation. The common carotid bifurcation was extremely calcified and diseased. Disease extended well into the left internal carotid artery. The internal carotid artery was quite small measuring roughly 5 mm in maximum diameter.
*
Description of operation: The patient was placed on the operating table in a supine position and adequate general anesthesia was administered monitoring the arterial pressure, electrocardiogram, and oxygen saturation. The entire left neck was prepped and draped in a sterile manner. A skin incision was placed on the anterior border of the left neck and deepened down through the platysma. The facial vein was doubly ligated and divided. The common, bifurcation, internal, and external carotid vessels were dissected out. An enlarged left internal jugular lymph node was excised and sent for pathology. Heparin was administered. With a satisfactory ACT greater than 250 seconds, the vessels were occluded and a common carotid arteriotomy was constructed and carried onto the internal carotid artery beyond the disease endpoint. An indwelling shunt was then placed in the usual manner. The endarterectomy was then carried out in the usual meticulous manner under optical magnification. Following satisfactory endarterectomy, the arteriotomy was closed utilizing 7-0 Prolene and a Hemashield patch. Before placing the last few sutures, the shunt was removed, flushing sequence was carried out, and the final sutures were placed tied and cut. Duplex analysis was carried out and findings are described above. Protamine was administered and hemostasis was obtained. The wound was closed in layers. Sterile dressing was applied. The patient was extubated in the operating room and taken to the recovery room in stable neurologic condition.
#1. Left carotid artery endarterectomy with Hemashield patch closure 35301 LT
#2. Post endarterectomy duplex analysis with interpretation 93882 26
#3. Excision of left internal jugular lymph node at the C sent to pathology for permanent evaluation) ?
*
Preoperative note: Patient is 63 y.o.-old female with severe left carotid artery disease now being taken to the operative for operative therapy.
*
Operative findings:
#1. Duplex findings: Following the endarterectomy the carotid artery was scanned in longitudinal and transverse planes including the common, bifurcation, internal, and external vessels. There were no filling defects or obstructive findings involving any of the vessels on on this imaging. Doppler analysis was carried out and the velocities in the meters per second are as follows: Common 47/11, bifurcation 38/0, external 41/0, internal 102/9.
#2. Operative findings: There was a significantly enlarged left internal jugular lymph node at the level of the carotid bifurcation. The common carotid bifurcation was extremely calcified and diseased. Disease extended well into the left internal carotid artery. The internal carotid artery was quite small measuring roughly 5 mm in maximum diameter.
*
Description of operation: The patient was placed on the operating table in a supine position and adequate general anesthesia was administered monitoring the arterial pressure, electrocardiogram, and oxygen saturation. The entire left neck was prepped and draped in a sterile manner. A skin incision was placed on the anterior border of the left neck and deepened down through the platysma. The facial vein was doubly ligated and divided. The common, bifurcation, internal, and external carotid vessels were dissected out. An enlarged left internal jugular lymph node was excised and sent for pathology. Heparin was administered. With a satisfactory ACT greater than 250 seconds, the vessels were occluded and a common carotid arteriotomy was constructed and carried onto the internal carotid artery beyond the disease endpoint. An indwelling shunt was then placed in the usual manner. The endarterectomy was then carried out in the usual meticulous manner under optical magnification. Following satisfactory endarterectomy, the arteriotomy was closed utilizing 7-0 Prolene and a Hemashield patch. Before placing the last few sutures, the shunt was removed, flushing sequence was carried out, and the final sutures were placed tied and cut. Duplex analysis was carried out and findings are described above. Protamine was administered and hemostasis was obtained. The wound was closed in layers. Sterile dressing was applied. The patient was extubated in the operating room and taken to the recovery room in stable neurologic condition.